Operating instrument insertion apparatus and operation supporting apparatus

ABSTRACT

There is provided an operating instrument insertion apparatus capable of easily inserting an operating instrument into the tissue. The operating instrument insertion apparatus includes a hollow tubular member for receiving an operating instrument therein, and a plurality of scoop-like members provided at a distal end of the hollow tubular member. The plurality of scoop-like members can be opened in such a manner that distal ends of the scoop-like members are moved away from each other in a direction transverse to an axial direction of said hollow tubular member, and the plurality of scoop-like members can be closed in such a manner that the distal ends of the scoop-like members are moved toward each other in this transverse direction, wherein the scoop-shape members in the opened condition cooperate so that an outside diameter formed thereby is no greater than an outside diameter of the hollow tube member.

CROSS REFERENCE TO RELATED APPLICATION

[0001] This is a continuation of U.S. application Ser. No. 09/520,850,filed Mar. 8, 2000, the subject matter of which is incorporated byreference herein.

BACKGROUND OF THE INVENTION

[0002] This invention relates to an operating instrument insertionapparatus for inserting an operating instrument to the affected partwhile incising the tissue.

[0003] JP-A-9-140659 discloses an endoscope comprising an operation bodyportion, an insertion portion connected to the operation body portionfor insertion into a body cavity, an illumination window provided at adistal end portion of the insertion portion, an observation windowprovided at the distal end portion of the insertion portion, a treatmentinstrument insertion channel provided in the distal end portion of theinsertion portion, a nozzle provided at the distal end portion of theinsertion portion for feeding air and water, and an operating knobmounted on the operation body portion for directing the distal endportion of the endoscope in a desired direction. The distal end surfaceof the distal end portion of the endoscope, at which the illuminationwindow, the observation window, the treatment instrument insertionchannel and the nozzle are provided, need to be flat, and therefore thedistal end portion of the endoscope has a substantially cylindricalouter shape. In this endoscope, consideration is given to the insertionof the insertion portion through the oral cavity and the pharynx intothe esophagus and further into the stomach and further into theduodenum, and in order to enable the insertion portion to be easilypassed through narrow portions of the insertion path, a cap, having astreamline-shaped distal end, is fitted on the distal end of theendoscope. This cap can be removed from the insertion portion byprojecting a forceps or the like from the distal end of the treatmentinstrument insertion channel.

[0004] The above conventional endoscope is designed to be inserted intoa cavity in the human body having the insertion spaces (though narrow)such as the oral cavity, the pharynx, the esophagus, the stomach and theduodenum. Therefore, any consideration is not given to the insertion ofthe operating instrument into the tissue for the purpose of treating theaffected part in the tissue.

SUMMARY OF THE INVENTION

[0005] It is an object of this invention to provide an operatinginstrument insertion apparatus capable of easily inserting an operatinginstrument into the tissue.

[0006] According to the present invention, there is provided anoperating instrument insertion apparatus comprising a hollow tubularmember for receiving an operating instrument therein, and a plurality ofscoop-like members provided at a distal end of the hollow tubularmember;

[0007] wherein the plurality of scoop-like members can be opened in sucha manner that distal ends of the scoop-like members are moved away fromeach other in a direction transverse to a direction of insertion of thescoop-like members into the tissue, and the plurality of scoop-likemembers can be closed in such a manner that the distal ends of thescoop-like members are moved toward each other in the transversedirection.

[0008] In this construction, the plurality of scoop-like members, whenopened, can spread the tissue, and by repeating this operation and theincision, the distal end of the tubular member can be inserted into aposition near to the affected part. When the plurality of scoop-likemembers are opened, a treatment space, enabling the operation of theoperating instrument, is formed between the distal end of the tubularmember and the distal ends of the scoop-like members, and therefore theoperating instrument can be projected into this space from the distalend of the tubular member so as to effect the treatment.

[0009] In the open condition of the plurality of scoop-like members, theoperating instrument for incision purposes may be projected from thedistal end of the tubular member so as to effect the incision.Alternatively, incision means such as a cautery knife may be provided atthe distal end of the scoop-like member, and the incision can beeffected in the closed condition of the plurality of scoop-like members.

BRIEF DESCRIPTION OF THE DRAWINGS

[0010]FIGS. 1A to 1C are views of a scoop-like member mechanismaccording to a first embodiment of an operating instrument insertionapparatus in accordance with the invention;

[0011]FIG. 2 is a cross-sectional, side elevational view of a drivemechanism of the apparatus of FIG. 1;

[0012]FIG. 3 is a side elevational view of a modified drive mechanism;

[0013]FIG. 4 is a side elevational view of another modified drivemechanism;

[0014]FIG. 5A to 5C are perspective views of a scope-like member havingan incision function according to another embodiment of the invention;

[0015]FIG. 6 is a side elevational view of an overall construction of anoperation supporting apparatus according to the invention; and

[0016]FIGS. 7A to 7D are perspective views of scoop-like members havingvarious shapes applicable to the above embodiments of the invention.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0017] A first embodiment of the present invention will now be describedwith reference to FIGS. 1 and 2.

[0018]FIG. 1A is a perspective view of a distal end portion of anoperating instrument insertion apparatus which can be inserted into thetissue, FIG. 1B is a cross-sectional view showing scoop-like orscoop-shape members in a closed condition, and FIG. 1C is across-sectional view showing the scoop-like members in an opencondition.

[0019] As shown in FIGS. 1A to 1C, the apparatus of this embodimentincludes the two scoop-like members 11 and 12, and the scoop-like member11, as well as the scoop-like member 12, can be pivotally moved aboutpivot points 21 and 22 disposed on a common line or axis. The scoop-likemembers 11 and 12 are mounted on one end surface or a distal end surfaceof a hollow tubular member 2 or a peripheral surface of a distal endportion thereof. As shown in FIG. 1A, the two pivot points, disposed onthe axis of pivotal movement, are provided at each scoop-like member.The cross-sectional shape of the hollow tubular member 2 is not limitedto a circular shape, but can be an oval shape or a polygonal shape. Inthe case where the hollow tubular member 2 has a polygonalcross-sectional shape, it is preferred that corner portions be rounded.

[0020] Operating force-transmitting plate-like members 31 and 32 areconnected respectively to the scoop-like members 11 and 12, and extendto the proximal end of the hollow tube 2, remote from the scoop-likemembers 11 and 12, over an outer peripheral surface thereof in thedirection of the length thereof. An outer tube 20 covers the hollow tube2, with the plate-like members 31 and 32 interposed between the hollowtube 2 and the outer tube 20. Thus, the plate-like members 31 and 32 areinterposed between the hollow tube 2 and the outer tube 20, and have aplate-like shape, and therefore the plate-like members 31 and 32 willnot be buckled and curved even when these plate-like members 31 and 32are pulled and compressed upon application of an operating force. Theplate-like members 31 and 32 have a sufficient rigidity to transmit thisoperating force. Further, the plate-like members 31 and 32 have such aflexibility that these members 31 and 32 are deformed along a curvedsurface of the distal end portion of the hollow tube 2 as shown in FIGS.1B and 1C.

[0021] In this embodiment, although each of the operatingforce-transmitting members 31 and 32 comprises a plate-like member, thisis not of absolute necessity, but can comprise a rigid wire such as apiano wire and a push rod, or any other suitable member. Each of theoperating force-transmitting members 31 and 32 may comprise a thin sheetof metal, e.g. stainless steel, passing through a sheath-like guidetube. Each of the operating force-transmitting members 31 and 32 may beformed integrally with the associated scoop-like member, or may be aseparate member connected to the associated scoop-like member.

[0022] When the plate-like members 31 and 32 are moved in a direction ofarrow f (FIG. 1B), the scoop-like members 11 and 12 are pivotally movedabout the pivot points as shown in FIG. 1C, so that the distal endsthereof are moved apart from each other in a direction transverse (orperpendicular) to a direction of insertion of the scoop-like membersinto the tissue, and are spaced a predetermined distance from eachother. The scoop-like members 11 and 12 are formed such that thedistance between their distal ends in this open condition is generallyequal to the outer diameter of the hollow tube 2.

[0023] The two scoop-like members 11 and 12 in their closed condition(FIG. 1) are inserted into the tissue of the internal organ, and thenthe plate-like members 31 and 32 are driven to bring the scoop-likemembers 11 and 12 into the open condition shown in FIG. 1C, so that thistissue is forcibly spread or opened by the two scoop-like members 11 and12. In this condition, an endoscope or an operating instrument,beforehand received in the hollow tube 2, is introduced into a space(formed between the distal end of the hollow tube 2 and the distal endsof the scoop-like members 11 and 12) formed in the tissue by thescoop-like members 11 and 12, so that the tissue of the internal organcan be observed or can be treated (see FIG. 5A).

[0024] In this condition, the incision and the hemostasis (if necessary)are effected. Then, the plate-like members 31 and 32 are moved in adirection opposite to the direction of arrow .t to bring the scoop-likemembers 11 and 12 into the closed condition shown in FIG. 1B, and thenthe scoop-like members 11 and 12 are inserted deeper into the tissue sothat the distal end of the endoscope or the operating instrument,received in the hollow portion of the hollow tube 2, can be insertedinto a predetermined position.

[0025] As described above, the two scoop-like members 11 and 12 have thefunction of spreading the relevant part of the tissue of the internalorgan by moving their distal ends apart from each other to thereby forma space enabling the operation of the operating instrument. The twoscoop-like members 11 and 12 also have the function of reducing theresistance which the hollow tube 2 receives during the insertingoperation, and further have the function of enabling the hollow tube 2to be less liable to be caught by the tissue.

[0026] In this embodiment, the two scoop-like members 11 and 12 may bereplaced by four or more scoop-like members.

[0027] In this embodiment, preferably, the scoop-like members are madeof a transparent material such as a plastics material so that they canbe inserted into the tissue while obtaining information through anendoscope, and by doing so, the operability is enhanced.

[0028] Next, a drive mechanism (operating mechanism) for operating thescoop-like members will be described with reference to FIG. 2.

[0029]FIG. 2 is a partly-cross-sectional, side-elevational view of thedrive mechanism portion.

[0030] The drive mechanism portion 3 for driving the scoop-like members11 and 12 is provided at the proximal end portion of the hollow tube 2(which comprises a flexibly-bendable tube as used in an endoscope)remote from the scoop-like members 11 and 12. The operating instrumentcan be inserted into the hollow portion (or the introducing tube) of thehollow tube 2 from the proximal end of this hollow tube 2 at which thedrive mechanism portion 3 is provided.

[0031] The drive mechanism portion 3 includes a spiral thread (screw) sof a relatively large size, formed on the outer peripheral surface ofthe hollow tube 2 (as shown in a cross-section portion d of FIG. 2), anda manually-driving member 51 in mesh with this threaded portion. Whenthe manually-driving member 51 is rotated about its axis by theoperator, this manually-driving member 51 is moved along the hollow tube2 through the threaded portion. A drive jig 52, to which the plate-likemembers 31 and 32 are connected, is connected to the manually-drivingmember 51 through a coupling c which can be freely rotated about itsaxis. Therefore, in accordance with the movement of the manually-drivingmember 51 along the hollow tube 2, the drive jig 52 is moved along thehollow tube 2, but is prevented from rotation about its axis. As aresult, the plate-like members 31 and 32 are moved in the direction ofthe length of the hollow tube 2, so that the scoop-like members 11 and12, provided respectively at the distal ends of the plate-like members31 and 32, are pivotally moved in such a manner that the distal ends ofthe scoop-like members 11 and 12 are moved between their open and closedpositions.

[0032] A modified drive mechanism portion (operating mechanism portion)3 will be described with reference to FIG. 3.

[0033]FIG. 3 is a side-elevational view of the drive mechanism portion3.

[0034] In this embodiment, the operator holds the drive mechanismportion 3 with the hand, and manually inserts the insertion apparatus. Arack gear 61 is formed on a drive jig 52 to which the plate-like members31 and 32 are connected, and the drive jig 52 is driven through a piniongear 62 in mesh with the rack gear 61. This pinion gear 62 is in meshwith another rack gear 63, and the operator manually operates a knob 65so as to drive the rack gear 63. Therefore, the drive jig 52 is movedalong the hollow tube 2. When the operator reverses the knob 65, aspring 64 fixed the rack gear 63 automatically drive the rack gear 63 toan initial position. Therefore, the plate-like members 31 and 32 aremoved in the direction of the length of the hollow tube 2, so that thescoop-like members 11 and 12, provided respectively at the distal endsof the plate-like members 31 and 32, are pivotally moved in such amanner that the distal ends of the scoop-like members 11 and 12 aremoved between their open and closed positions.

[0035] Another modified drive mechanism portion (operating mechanismportion) 3 will be described with reference to FIG. 4.

[0036]FIG. 4 is a side-elevational view of the drive mechanism portion.

[0037] The plate-like members 31 and 32 are connected to rack gears 311and 321, respectively, and these rack gears 311 and 321 are in mesh withpinion gears 312 and 322, respectively. The pinion gears 312 and 322 aredriven respectively by actuators which are pulse motors 313 and 323,respectively, in this example. When the operator operates an operationinput switch (not shown in FIG. 4) for controlling the pulse motors 313and 323, the plate-like members 31 and 32 are driven, and as a resultthe scoop-like members 11 and 12, provided respectively at the distalends of the plate-like members 31 and 32, are pivotally moved in such amanner that the distal ends of the scoop-like members 11 and 12 aremoved between their open and closed positions. Thus, the operator cancontrol the operation of the scoop-like members 11 and 12 only byoperating the switch, and therefore the operability is greatly enhanced.

[0038] The manner of using the insertion apparatus of the aboveembodiment (FIGS. 1 to 4) will be described with reference to FIGS. 5Ato 5C.

[0039] When the scoop-like members are to be inserted into the tissue ofthe non-tubular internal organ, the scoop-like members are combinedtogether to jointly form a cone-shaped portion having a pointed distalend, and this cone-shaped portion is slightly inserted into the tissueof the internal organ while incising (or cutting) the surface of thistissue only at an initial stage of this inserting operation.

[0040] When the cone-shaped portion is this slightly inserted into thetissue, the plurality of scoop-like members are opened (or spread out)in such a manner that the distal ends thereof are moved apart from eachother, thereby forcibly spreading the tissue of the internal organ. Theopen end of the hollow tube (tubular member) 2 is disposed at theproximal ends of the scoop-like members 11 and 12 as shown in FIG. 5A,and an endoscope 201 or an operating instrument 202 is projectedoutwardly from the hollow tube 2 through this open end, and thereforethe tissue of the internal organ can be observed, or a suitabletreatment can be effected for the affected part of this tissue. Namely,by providing the endoscope or the operating instrument in the hollowtube (tubular member) 2, an operation supporting apparatus can beprovided.

[0041] For further inserting the scoop-like members into the tissue ofthe internal organ, this tissue is incised by a cautery knife or thelike to thereby provide an insertion port, and a treatment such ashemostasis is performed, and then the plurality of scoop-like membersare again moved into the closed condition, and the cone-shaped portionis inserted into the tissue.

[0042] Thus, the apparatus of the invention has the mechanism fordriving the plurality of scoop-like members so as to secure a space, andalso has the hollow portion through which an operating instrument, forexample, for incision purposes can be passed. Therefore, the scoop-likemembers are spread out (or opened) to secure a space, and in thiscondition the tissue is incised, and then the scoop-like members areagain closed into the cone-shape, and can be inserted into the tissue.

[0043] The scoop-like members in the closed condition is slightlyinserted into the tissue, and are opened to forcibly spread this tissueto form a space. Then, the tissue is observed by an endoscope receivedin the hollow tube, and the incision and hemostasis are effected by theoperating instrument received in the hollow tube. Then, the scoop-likemembers are again closed, and are inserted deeper into the tissue. Byrepeating this operation, the scoop-like members can be inserted intothe tissue of the internal organ, such as the brain and the liver, whileeffecting the necessary treatments.

[0044] As shown in FIG. 53, an incision function such as a cautery knifecan be provided at the distal end of the scoop-like member, and by doingso, the operability can be further enhanced. In this case, when thescoop-like members are spread out (or opened), the organ tissue can bedirectly incised while effecting the hemostasis. At this time, thetreatment can be effected while observing the tissue through anendoscope or the like provided in the hollow tube 2.

[0045] In this case, as shown in FIGS. 5B and 5C, the scoop-like memberis made of a resin, and an electrode 210, 220 of the metal cautery knifeis provided at the distal end thereof, and extends like a wire 211, 221.

[0046] An embodiment of an overall system, utilizing the apparatus shownin FIGS. 1A to SC, will be described with reference to FIG. 6.

[0047]FIG. 6 is a side-elevational view showing the system constructionof the operation supporting apparatus.

[0048] In this embodiment, the insertion apparatus, comprisingscoop-like members 1, the hollow tube 2 and the drive mechanism portion3, is held by a holding device 100, and the insertion apparatus isinserted into the tissue of the internal organ. In this embodiment, theinsertion apparatus can be positioned in X-, Y- and Z-directions by anX-, Y- and Z-axis drive portion 110, and the rotation 13 of theinsertion apparatus can be effected by a rotation (/3) drive portion111, and the rotation a can be effected by a rotation (a) drive portion112, and the translation t can be effected by a translation (t) driveportion 113. These drive portions can be operated by operation inputmeans 102 through a control unit 101, and therefore the distal end ofthe hollow tube 2 can be easily located at the affected part. Withrespect to the translation (t) drive portion 113, a ball thread portion115 is driven, so that a moving portion 114 in mesh with the ball threadportion 115 is moved, thereby effecting the translational movement.

[0049] With this construction, the operator does not need to hold theinsertion apparatus with the hand, and therefore the operability isgreatly enhanced. For moving the insertion apparatus in a direction ofarrow j, the operator operates an operating lever 102 in accordance withthis inserting direction so as to drive a drive device for controllingthe upward and downward movement.

[0050]FIGS. 7A to 7D show various shapes of scoop-like members which canbe used in the above embodiments.

[0051] The scoop-like member, shown in FIG. 7A, is linearly taperingtoward its pointed distal end, and the resistance to the insertion ofthis scoop-like member is small. The scoop-like member, shown in FIG.73, is generally spatulate, and has a distal end portion of arelatively-large width, and when these scoop-like members are spread out(or opened), a space of a relatively large size can be secured. Thescoop-like member, shown in FIG. 7C, is tapering toward its pointeddistal end, with its distal end portion bulged or curved, and arelatively large space is defined by the inner surface of thisscoop-like member. The scoop-like member, shown in FIG. 7D has a roundeddistal end, and can be inserted into a relatively-soft tissue.

[0052] In the present invention, the plurality of scoop-like members areprovided at the distal end of the hollow tubular member into which theoperating instrument can be inserted. The plurality of scoop-likemembers can be opened in such a manner that the distal ends of thescoop-like members are moved away from each other in the directiontransverse to the direction of insertion of the scoop-like members intothe tissue, and the plurality of scoop-like members can be closed insuch a manner that the distal ends of the scoop-like members are movedtoward each other in this transverse direction. Thus, the scoop-likemembers can be repeatedly moved between their closed and open positions.Therefore, the relevant part of the tissue can be spread by opening theplurality of scoop-like members, and by repeating this operation and theincision of the tissue, the distal end of the tubular member can beinserted into a position near to the affected part.

What is claimed is:
 1. An operating instrument insertion apparatuscomprising a hollow tubular member for receiving an operating instrumenttherein, and a plurality of scoop-shape members provided at a distal endof said hollow tubular member; wherein said plurality of scoop-shapemembers have a distal end, said plurality of scoop-shape members can beopened in such a manner that the distal ends of said scoop-shape membersare moved away from each other in a direction transverse to an axialdirection of said hollow tubular member, and said plurality ofscoop-shape members can be closed in such a manner that the distal endsof said scoop-shape members are moved toward each other in saidtransverse direction; wherein said scoop-shape members in the openedcondition cooperate so that an outside diameter formed thereby is nogreater than an outside diameter of said hollow tube member.
 2. Anoperating instrument insertion apparatus comprising a hollow tubularmember for receiving an operating instrument therein, and a plurality ofscoop-shape members provided at a distal end of said hollow tubularmember; wherein said plurality of scoop-shape members have a distal end,said plurality of scoop-shape members are pivotally connected to thedistal end of said tubular member so as to be pivotally moved radiallyof said tubular member; there is provided an operating mechanism portionwhich can open said plurality of scoop-shape members in such a mannerthat the distal ends of said scoop-shape members are moved away fromeach other in a direction transverse to an axial direction of saidhollow tubular member, and said operating mechanism can close saidplurality of scoop-shape members in such a manner that the distal endsof said scoop-shape members are moved toward each other in saidtransverse direction; wherein said scoop-shape members in the openedcondition cooperate so that an outside diameter formed thereby is nogreater than an outside diameter of said hollow tube member.
 3. Anoperating instrument insertion apparatus comprising a hollow tubularmember for receiving an operating instrument therein, a plurality ofscoop-shape members provided at a distal end of said hollow tubularmember; wherein said plurality of scoop-shape members have a distal endsaid plurality of scoop-shape members are pivotally connected to thedistal end of said tubular member; and wherein a plurality of operatingmembers are connected respectively to said scoop-shape members so as topivotally move said scoop-shape members, and extend to the other end ofsaid tubular member along said tubular member; wherein said scoop-shapemembers in the opened condition cooperate so that an outside diameterformed thereby is no greater than an outside diameter of said hollowtube member.
 4. An operating instrument insertion apparatus comprising ahollow tubular member for receiving an operating instrument therein, anda plurality of scoop-shape members provided at a distal end of saidhollow tubular member; wherein said plurality of scoop-shape membershave a distal end, said plurality of scoop-shape members can be openedin such a manner that the distal ends of said scoop-shape members aremoved away from each other in a direction transverse to an axialdirection of said hollow tubular member, and said plurality ofscoop-shape members can be closed in such a manner that the distal endsof said scoop-shape members are moved toward each other in saidtransverse direction; wherein when said scoop-shape members are opened,a space, into which said operating instrument can be projected from thedistal end of said tubular member, is formed between the distal ends ofsaid scoop-shape members and the distal end of said tubular member; andwherein said scoop-shape members in the opened condition cooperate sothat an outside diameter formed thereby is no greater than an outsidediameter of said hollow tube member.
 5. An operating instrumentinsertion apparatus comprising a hollow tube, and a plurality ofscoop-shape members pivotally connected to a distal end of said tube;wherein said plurality of scoop-shape members, when closed to becombined together, jointly form a generally cone-shaped portion,tapering toward a distal end thereof, and covers a surface of the distalend of said tube, and when said plurality of scoop-shape members arespread away from an axis of said cone-shaped portion, the distal ends ofsaid scoop-shape members are moved away from each other, and aredisposed on a circle no larger than an outer diameter of said tube;wherein an operating force-transmitting member is connected at a distalend thereof to each of said scoop-shape members, and extends so as tohave a length along said tube, and a proximal end of said operatingforce-transmitting member is connected to a drive mechanism providednear a proximal end of said tube.
 6. An operating instrument insertionapparatus according to any one of claims 1 to 5, in which each of saidscoop-shape members is made of a transparent material.
 7. An operatinginstrument insertion apparatus according to claim 5, in which said drivemechanism can drive said operating force-transmitting member in adirection of the length thereof.
 8. An operation supporting apparatuscomprising a hollow tubular member for receiving an operating instrumenttherein, and a plurality of scoop-like members provided at a distal endof said hollow tubular member; wherein said plurality of scoop-likemembers can be opened in such a manner that distal ends of saidscoop-like members are moved away from each other in a directiontransverse to an axial direction of said hollow tubular member, and saidplurality of scoop-like members can be closed in such a manner that thedistal ends of said scoop-like members are moved toward each other insaid transverse direction; wherein the operating instrument is insertedin said tubular member; and wherein said scoop-shape members in theopened condition cooperate so that an outside diameter formed thereby isno greater than an outside diameter of said hollow tube member